CCRC Opco - Holland, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

704011 Issued in MI

Legal business name

CCRC OPCO - HOLLAND, LLC

Doing business as

The Inn at Freedom Village

Practice address

145 Columbia Ave
Holland, MI 49423-2981

Phone

(616) 820-7400

Fax

(616) 820-7410

NPI assigned

May 11, 2006

Organization subpart

Yes

Parent organization

BROOKDALE SENIOR LIVING INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bryan Richardson

Title

Cao

Phone

(615) 221-2250

Specialties & licenses 1

Addresses

Other names 1

• The Inn at Freedom Village Doing business as

Tax ID family

CCRC Opco - Holland LLC2 organizations share this tax ID, including this one

Part of

Brookdale Senior Living Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• CCRC Opco - Holland, LLC

  dba The Inn at Freedom Village

  • Skilled Nursing Facility
  • Holland, MI
  • NPI 1245644509
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412812800000",
    "number": "1568412690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 COLUMBIA AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494232981",
            "telephone_number": "616-820-7400",
            "fax_number": "616-820-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 COLUMBIA AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494232981",
            "telephone_number": "616-820-7400",
            "fax_number": "616-820-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OPCO - HOLLAND, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKDALE SENIOR LIVING INC",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-10-09",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "615-221-2250"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "704011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Inn at Freedom Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sandra Candy Castle, LLP
• Diego Castro Franco, TLLP
• Chris Alan Causey, MA
• Jill Maree Cavazos, COTA/L
• CCRC Opco - Holland, LLC (The Inn at Freedom Village)
• Joshua Adam Cebula, D.C
• Jodi Lynn Cech
• Center for Advanced Interventional Spine Treatment PLC
• Center for Family Development
• Donald Morris Chaffee III, M.D.

• Skilled Nursing Facility in Holland, MI
• Providers in Holland, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.